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1 April, 2019 00:00 00 AM
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Understanding autism

Autism Speaks
Understanding autism

There is no one type of autism, but many.

Autism, or autism spectrum disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. According to the Centers for Disease Control, autism affects an estimated 1 in 59 children in the United States today.

We know that there is not one autism but many subtypes, most influenced by a combination of genetic and environmental factors. Because autism is a spectrum disorder, each person with autism has a distinct set of strengths and challenges.

The ways in which people with autism learn, think and problem-solve can range from highly skilled to severely challenged. Some people with ASD may require significant support in their daily lives, while others may need less support and, in some cases, live entirely independently.

Several factors may influence the development of autism, and it is often accompanied by sensory sensitivities and medical issues such as gastrointestinal (GI) disorders, seizures or sleep disorders, as well as mental health challenges such as anxiety, depression and attention issues.

Indicators of autism usually appear by age 2 or 3. Some associated development delays can appear even earlier, and often, it can be diagnosed as early as 18 months. Research shows that early intervention leads to positive outcomes later in life for people with autism.

Autism’s core symptoms are

social communication challenges and

restricted, repetitive behaviors.

In autism, these symptoms

begin in early childhood (though they may go unrecognized)

persist and

interfere with daily living.

Specialized healthcare providers diagnose autism using a checklist of criteria in the two categories above. They also assess symptom severity. Autism’s severity scale reflects how much support a person needs for daily function.

Many people with autism have sensory issues. These typically involve over- or under-sensitivities to sounds, lights, touch, tastes, smells, pain and other stimuli.

Autism is also associated with high rates of certain physical and mental health conditions.

Social communication challenges

Children and adults with autism have difficulty with verbal and non-verbal communication. For example, they may not understand or appropriately use:

Spoken language (around a third of people with autism are nonverbal)

Gestures

Eye contact

Facial expressions

Tone of voice

Expressions not meant to be taken literally

Additional social challenges can include difficulty with:

Recognizing emotions and intentions in others

Recognizing one’s own emotions

Expressing emotions

Seeking emotional comfort from others

Feeling overwhelmed in social situations

Taking turns in conversation

Gauging personal space (appropriate distance between people)

Restricted and repetitive behaviors

Restricted and repetitive behaviors vary greatly across the autism spectrum. They can include:

Repetitive body movements (e.g. rocking, flapping, spinning, running back and forth)

Repetitive motions with objects (e.g. spinning wheels, shaking sticks, flipping levers)

Staring at lights or spinning objects

Ritualistic behaviors (e.g. lining up objects, repeatedly touching objects in a set order)

Narrow or extreme interests in specific topics

Need for unvarying routine/resistance to change (e.g. same daily schedule, meal menu, clothes, route to school)

What causes autism?

One of the most common questions asked after a diagnosis of autism, is what caused the disorder.

We know that there’s no one cause of autism. Research suggests that autism develops from a combination of genetic and nongenetic, or environmental, influences.

These influences appear to increase the risk that a child will develop autism. However, it’s important to keep in mind that increased risk is not the same as cause. For example, some gene changes associated with autism can also be found in people who don’t have the disorder. Similarly, not everyone exposed to an environmental risk factor for autism will develop the disorder. In fact, most will not.

Autism’s genetic risk factors

Research tells us that autism tends to run in families. Changes in certain genes increase the risk that a child will develop autism. If a parent carries one or more of these gene changes, they may get passed to a child (even if the parent does not have autism). Other times, these genetic changes arise spontaneously in an early embryo or the sperm and/or egg that combine to create the embryo. Again, the majority of these gene changes do not cause autism by themselves. They simply increase risk for the disorder

Autism’s environmental risk factors

Research also shows that certain environmental influences may further increase – or reduce – autism risk in people who are genetically predisposed to the disorder. Importantly, the increase or decrease in risk appears to be small for any one of these risk factors:

Increased risk

Advanced parent age (either parent)

Pregnancy and birth complications (e.g. extreme prematurity [before 26 weeks], low birth weight, multiple pregnancies [twin, triplet, etc.])

Pregnancies spaced less than one year apart

Decreased risk

Prenatal vitamins containing folic acid, before and at conception and through pregnancy

No effect on risk

Vaccines. Each family has a unique experience with an autism diagnosis, and for some it corresponds with the timing of their child’s vaccinations. At the same time, scientists have conducted extensive research over the last two decades to determine whether there is any link between childhood vaccinations and autism. The results of this research is clear: Vaccines do not cause autism. The American Academy of Pediatrics has compiled a comprehensive list of this research.

Differences in brain biology

How do these genetic and nongenetic influences give rise to autism? Most appear to affect crucial aspects of early brain development. Some appear to affect how brain nerve cells, or neurons, communicate with each other.

Others appear to affect how entire regions of the brain communicate with each other. Research continues to explore these differences with an eye to developing treatments and supports that can improve quality of life.

What is Asperger syndrome?

Asperger syndrome, or Asperger’s, is a previously used diagnosis on the autism spectrum. In 2013, it became part of one umbrella diagnosis of autism spectrum disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5).

Typical to strong verbal language skills and intellectual ability distinguish Asperger syndrome from other forms of autism.

It generally involves:

Difficulty with social interactions

Restricted interests

Desire for sameness

Distinctive strengths

Strengths can include:

Remarkable focus and persistence

Aptitude for recognizing patterns

Attention to detail

Challenges can include:

Hypersensitivities (to lights, sounds, tastes, etc.)

Difficulty with the give and take of conversation

Difficulty with nonverbal conversation skills (distance, loudness, tone, etc.)

Uncoordinated movements, or clumsiness

Anxiety and depression

The tendencies described above vary widely among people. Many learn to overcome their challenges by building on strengths.

Though the diagnosis of Asperger syndrome is no longer used, many previously diagnosed people still identify strongly and positively with being an “Aspie.”

Therapies and services

Cognitive behavioral therapy can help address anxiety and other personal challenges.

Social skills training classes can help with conversational skills and understanding social cues.

Speech therapy can help with voice control.

Physical and occupational therapy can improve coordination.

Psychoactive medicines can help manage associated anxiety, depression and attention deficit and hyperactivity disorder (ADHD).

How has our understanding evolved?

1944: Austrian pediatrician Hans Asperger described four strikingly similar young patients. They had normal to high intelligence. But they lacked social skills and had extremely narrow interests. The children also shared a tendency to be clumsy.

1981: British psychiatrist Lorna Wing published a series of similar case studies. In it, she coined the term “Asperger syndrome.”

1994: Asperger syndrome listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-4).

2003: Asperger syndrome and other previously separate types of autism folded into one umbrella diagnosis of “autism spectrum disorder” in DSM-5.

Screening & diagnosis

The American Academy of Pediatrics recommends that all children be screened for autism at their 18 and 24-month well-child checkup. If you're not sure if your child has been screened, you can ask for a screening. You can also complete the online screener, print the results, and bring them to your healthcare provider to discuss your concerns.

If the screener shows that your child may have a greater chance of having autism - it is not a diagnosis. You should speak with your child's healthcare provider about getting a full evaluation from a qualified medical specialist such as a neurologist, behavior pediatrician, or psychiatrist, who can provide a diagnosis.

In the meantime, you don't need to wait for a diagnosis of autism to receive services to address related developmental delays and learning challenges. You can access these services free of charge through your state's Early Intervention program (ages birth - 3) or your school district's Special Education Office (age 3 - 21). Research shows that early intervention can provide the best outcomes.

 Even if your child is receiving services through early intervention or your school district, and their screening indicated an increased risk for autism, you do want to get a full evaluation. That evaluation may result in a diagnosis If you get a diagnosis of autism, you want to contact your early intervention provider or school district and let them know. The diagnosis may help to provide access to autism specific treatments.

It's important to remember that if your child does receive a diagnosis of autism. He or she is the same child as before the diagnosis. The diagnosis provides access to the services that he needs.

 

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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